frequency of anxiety and depression in chronic hepatitis c patients recieving direct-acting antiviral agents

Conditions: Chronic Hepatitis c

Summary: the primary objective of this study is to prospectively analyse psychiatric outcomes, specifically depression and anxiety in patients with hepatitis c virus infection who are initiated on daa therapy (sofosbuvir based regimen).

hepatitis c is a major cause of chronic liver disease worldwide with an estimated 71 million people infected in 2015 and approximately 1.75 million new infections each year . egypt had high burden of liver disease from viral hepatitis , and near to 15% of the adult population had hcv seropositivity and more than 4 million persons had also viraemia . the discovery of direct-acting antiviral agents (daas) has dramatically changed hcv treatment by increasing the cure rate and decreasing the duration of therapy .the current generation of daas (e.g., daclatasvir \[dcv\], sofosbuvir \[sof\], simeprevir \[sim\] and ledipasvir \[ldv\]) is used without ifn . the approval of direct - acting antiviral (daa) agents revolutionized hcv treatment and allowed for non-ifn-a-based regimens. psychiatric and psychosocial contraindications to treatment are reduced due to shorter duration of therapy and improved side effect profiles . also, the favorable side effect profiles of daa agents (less fatigue and blood dyscrasias) lead to high adherence rates of 96.2%, compared to 84.3% and 77.6% in ifn-free rbv-containing regimens and ifn- and rbv containing regimen respectively . sofosbuvir and daclatasvir are new direct acting antivirals (daas) which are tolerable and safe. daclatasvir is a first-in-class hcv ns5a replication complex inhibitor with pangenotypic activity and can be used once-daily. sofosbuvir is an orally administered hcv nucleotide polymerase ns5b inhibitor. it is given once daily with a good safety profile . the sofosbuvir and daclatasvir combination is associated with a high rate of svr in difficult-to-treat patients infected with genotype 1 or 4. addition of ribavirin increases the svr rate in cirrhotic and treatment-experienced patients . mental illness are significantly higher in chronic hcv patients than in the general population, with depression, schizophrenia, and bipolar disorder occurring at 25%, 3.9%, and 2.6% respectively . hcv infection lead to psychiatric symptoms by inflammatory routes, direct brain neurotoxicity, metabolic and neurotransmitter pathway derangement and immune-mediated responses . currently, the extent of psychiatric effects attributed to daa agents is unclear; however, it is less than ifn-containing regimens . though data suggests that daas confer a minimal risk of psychiatric adverse effects compared to ifn-based regimens; there is a paucity of data specifically adressing neuropsychiatric complications of these drugs. in addition, it is unclear whether daa therapy may exacerbate mood symptoms in patients with prior psychiatric history .

Eligibility criteria:
inclusion criteria: 18 years and older chronic hepatitis c infection naive patients who will start a 12-week daa therapy acceptance to share in study exclusion criteria: recieving antipsychotic . previous failure of daa agents. significant life-threatening diseases hcv related liver cirrhosis. non hcv related liver disease